Diabetes Drug Chart
Drug Action
Insulin
Lispro-rapid acting
Regular-short acting
NPH-intermediate acting
Ultralente-long acting
Sulfonylureas
Incr.
1st gen: tolbutamide (ORINASE)
nd
2 gen: glipizide
(GLUCOTROL)
INSULIN
Insulin Enhancers
Repanglinide, (PRANDIN)
SECRETION
Nateglinide (STARLIX)
Decr. Glucose production
Biguanides
Metformin
(GLUCOPHAGE)
Stop Gut N-Zymes
Alpha-glucosidase
inhibitors
acarabose (PRECOSE)
miglitol (GLYSET)
Use
-stimulates glucose uptake by fat
and muscle cells
-promotes glycogen formation in
liver & muscle cells
-blocks K channel in the
membrane of pancreatic ß cells;
depolarizes cell & stimulates
release of insulin
-may also decr. hepatic glucose
production (glyconolysis and
gluconeogenesis) and incr. tissue
responsiveness to insulin
-promotes insulin secretion by the
pancreas
-stimulates insulin secretion by
pancreas
- extent of insulin release is glucose
dependent (‘smart drug’)
- decr. hepatic glucose
production
- incr. peripheral insulin
sensitivity esp. in muscle tissue
-prolongs digestion of CHO
-decr. peak plasma glucose levels
by inhibiting intestinal enzymes
in SI that break complex
carbohydrates into smaller
molecules
Side Effects
-used for Type 1 diabetes
-used for Type 2 diabetes,
not controlled by diet
and/or oral hypoglycemics
-for Type 2 diabetics
2nd generation:
-fewer side effects
-more predictable action times &
half-lives
-fewer DDIs-bind to proteins
differently
-more expensive
-for type 2 diabetics
-used alone or in combo
therapy w/ Metformin or
Glyburide
-for type 2 diabetes
-for treatment of type 2
diabetes, alone or w/ a
sulfonylurea
-does not cause
hypoglycemia-an
antihyperglycemic drug
-for treatment of type 2
diabetes
aka “starch-blockers”
Nursing Implications
-metabolic derangements w/
inadequate therapy—
ketoacidosis or
hypoglycemic coma
-lipoatrophy at injection
sites
-allergies
-GI distress
-dizziness, drowsiness, HA
-allergies—skin rxs
-hypoglycemia
-weight gain
-hypoglycemia
-GI: same as metformin
-GI effects—anorexia,
flatulence, metallic taste,
N/V, stomach pain, weight
loss
- Weight loss
- Decr. absorption of
vitamin B12 and folic acid
-GI: flatulence, abdominal
pain, distenion, diarrhea,
borborygmi
-Incr. in liver enzymes
-teach proper monitoring and
management of blood sugar levels
-teach S/Sx of hypo/hyperglycemia
-rotate injection sites
DDIs: moderate to high alcohol
consumption inc. hypoglycemic action of
insulin
-beta-adrenergic agents or corticosteroids
may antagonize actions of insulin and
mask hypoglycemic state
-not to be used w/ renal or liver impaired
patients
DDIs: sulfonamides, salicylates,
phenylbutazon : hypoglycemia
-thiazides: hyperglycemic activity
-beta-adrenergic blocking agents
-disulfiram-like rx or possible
hypoglycemia w/ alcohol
-patients must eat w/i 30 minutes of
administration
- Give 1-30 minutes before meals
- Category C: do not use during
pregnancy
- Avoid in patients w/ severe liver insuff
- Works more quickly than Prandin
-Avoid in patients w/ severe liver or
renal dx, cardiorespiratory insufficiency,
CHF
DDIs: avoid alcohol—hypoglycemic
cimetidine, digoxin, morphine, rantidine,
trimethorprim, furosemide,
vancomycin—incr. blood concentration
of metformin
-used as mono or combo therapy w/
sulfonylureas
-TID w/ first bite of food
-SE diminish w/ time—usually 3 wks
DDIs: corticosteroids & thiazides—
interfere w/ control of hyperglycemia
 Drug Action Use Side Effects Nursing Implications
Decr. insulin resistance

-acts on target tissues to decr. insulin -for treatment of type 2 -edema, weight gain -cytochrome P450 inducer so check
Thiazolidinediones liver function: 1st six months-check
resistance in skeletal muscle diabetes; mono or combo -anemia
(Glitazones) monthly; 2nd six months-check
-may also decr. glucose output by the therapy
rosiglitazone (AVANDIA) liver every 2 months
pioglitazone (ACTOS) -teach patient of liver failure signs
DDIs: Ca channel blocking agents
corticosteroids, statins and BC pills

BLOOD GLUCOSE
LOWERING EFFECTS

Glucose Lowering Effect Glucose Raising Effect

Acetaminophen
Alcohol Beta-adrenergic blockers
Allopurinol Birth control pills
Aspirin (large doses) Cholestryramine (Questran)
Alpha-glucosidase inhibitors Corticosteroids
Beta-adrenergic blockers Ethacrynic acid
Biguanides Morphine
Clofibrate Epinephrine
Histamine antagonists Furosemide (LASIX)
Insulin Glucagons
MOA inhibitors Lithium
Probenecid Nicotine
Sulfonylureas Nifedipine
Troglitazone Phenobarbital
Tricyclic antidepressants Pnenothiazines
Urinary acidifiers Phenytoin (DILANTIN)
Rifampin
Thiazide diuretics
Urinary alkalizing agents